II. Indications
- T-Cell Lymphoma (relapsed or refractory)
III. Contraindications
- Caution in Chronic Kidney Disease
IV. Mechanism
- Anti-Folate agent active as an antineoplastic and Immunosuppressant
- Targets cells expressing RFC-1 (reduced Folate carrier-1)
-
Folate analog inhibitor of dihydrofolate reductase (DHFR)
- Blocks Tetrahydrofolate synthesis
- Depletes Nucleotide precursors
- Inhibits DNA, RNA and Protein synthesis
V. Medications
- Pralatrexate IV Solution 20 mg/ml in 1 to 2 ml vials
VI. Dosing
- See other references for disease specific dosing protocols
- Adult: 30 mg/m2 IV once weekly for 6 weeks, followed by 1 week of no Pralatrexate
- Coadministered agents to reduce adverse effects (e.g. mucositis)
- Folic Acid 1 to 1.25 mcg orally daily
- Start 10 days before, and continue for 30 days after last Pralatrexate dose
- Vitamin B12 1000 mcg IM
- Give one dose within 10 weeks of starting Pralatrexate
- Repeat Vitamin B12 dosing every 10 weeks while taking Pralatrexate
- Folic Acid 1 to 1.25 mcg orally daily
VII. Adverse Effects
- Hepatotoxicity
- Myelosuppression
- Mucositis
- Life-Threatening Drug-Induced Rashes (e.g. Toxic Epidermal Necrolysis)
VIII. Safety
- Avoid in Pregnancy (any trimester)
- Use reliable Contraception
- Avoid in Lactation
IX. Drug Interactions
- Drugs that prolong Pralatrexate activity (decreased clearance)
X. Resources
- Pralatrexate (DailyMed)